INSTRUCTIONS FOR FORM WV/RAF-3 
    (CHARITABLE RAFFLE FINANCIAL REPORTS) 
 
Raffle financial reports must be filed within thirty days after the expiration of the 
license, on forms provided by the Tax Commissioner. WVC § 47-21-22. 
 
(HEADING): The heading of the financial report must include the name and 
address of the organization that holds the license, the identification number and 
account number issued to the organization by letter from the State Tax 
Department, and the date that the letter was issued. 
 
REPORT PERIOD: The same form is used for annual or limited occasion 
reports. Indicate the report period in the box provided. Check the box provided if 
the report is an annual report. 
 
CALCULATION OF ENDING BALANCE 
 
(Complete schedules A, B and C on page 2 of the form  before filling out this 
section.) 
 
Line Number 
 
 1.  Total Gross Proceeds. Enter the amount from Schedule A, Line 4. 
 
 2.  Total All Prizes. Enter the amount from Schedule B, Line 5. 
 
 3.  Total Raffle Expenses. Enter the amount from Schedule C, Line 9. 
 
 4.  Net Profit or Loss. Subtract Prizes (Line 2) and Expenses (Line 3) from 
    Gross Proceeds (Line 1). Losses should be written in parentheses. 
 
 5. Beginning  Balance  (Enter the unexpended balance at the end of the 
    previous license year). The licensee MUST distribute funds equal to or 
    greater than this amount to charitable or public service purposes during 
    the ensuing license year; e.g., funds earned in the year 2000 must be 
    donated before the end of 2001. 
 
 6. Other deposits in Raffle Account. Enter the dollar amount of any special 
    deposits into the raffle account during the license year. 
 
 7.  Adjustments in Raffle Account. This should include ALL other deposits or 
    credits not reported on Line 6.  For example:  interest earned on deposits. 
    A detailed explanation of any amounts reported on this line must be 
    attached to the financial report. 

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 8.  Monies Transferred to Bingo Account to Cover Losses 
 
 9.  Amounts Contributed to Organizations this Year. This includes donations 
  to the licensee, if it is a qualified recipient organization.  
 
 10.  Ending Unexpended Balance. Add lines 4, 5, 6, and 7, then subtract lines 
  8 and 9.  The unexpended  balance reported here should be the same 
  amount as reported in the raffle bank account at the end of the reporting 
  period.  This amount MUST be distributed for charitable or public service 
  purposes during the 12-month period immediately succeeding the end of 
  this reporting period. 
 
 11. Year End Inventory (Dollar amount paid for games on hand) This figure 
  will be reported so as to reflect the cost to the licensee for these items. 
 
 12.  Percentage Used to Pro-Rate Expenses (If Applicable) 
 
NAME OF THE BANK AND RAFFLE CHECKING ACCOUNT NUMBER  
 
Enter the name of the bank where the raffle checking account is held, along with 
the account number. 
 
CONCESSIONS 
 
Enter the name of the concession operator, if it is not the licensee. 
 
Calculate the net profit or loss (line 3) from concessions by subtracting the 
expenses (line 2) from the receipts (line 1). 
 
SCHEDULE A – GROSS PROCEEDS 
 
 Line Number 
  
 1.  Sale of raffle tickets—all revenue generated through raffle ticket sales 
  during the reporting period should be reported here.  
 
 2.  Donated prizes—all prizes donated to the licensee and awarded as prizes 
  during the reporting period, must be reported here.  The amount reported 
  shall be the fair market value of the prize at the time of acquisition.   
 
 3.  Any other receipts received by the licensee during the reporting period 
  shall be reported here. Any moneys received by the licensee for providing 
  child care services related to the raffle occasion shall be reported here. 
 
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 4. Total Gross Proceeds must equal the sum of lines 1 – 3. Enter this 
    number on Page 1, Line 1. 
 
SCHEDULE B – PRIZE PAYOUTS 
 
 1.  The amount of money awarded as prizes, either by cash or check, must 
    be reported here. 
 
 2.  The fair market value of all merchandise purchased by the licensee and 
    awarded as prizes must be reported here. 
 
 3.  The fair market value of all prizes donated to the licensee and awarded as 
    prizes must be reported here. 
 
 4.  The fair market value of any door prizes awarded during the reporting 
    period shall be reported here. 
 
 5.   The TOTAL value of ALL prizes awarded during the reporting period (the 
    sum of lines 1 – 4) shall be reported here. Enter this number on Page 1, 
    Line 2. 
 
SCHEDULE C – RAFFLE EXPENSES  
 
 1.  Rental of premises used for raffle occasions. 
 
 2.   Salaries and related payroll taxes shall be reported here. 
 
 3.   Losses from bad checks during the reporting period shall be reported 
    here. 
 
 4.   Cost of utilities incurred in connection with raffle activities during the 
    reporting period shall be reported here. 
 
 5.   Cost of raffle supplies (boards and games) incurred during the reporting 
    period shall be reported here.  Only the amounts of actual payments shall 
    be reported. 
 
 6.   Cost of custodial services, security and child care services incurred in 
    connection with raffle activities  during the reporting period shall  be 
    reported here. 
 
 7.   Cost of maintenance and repairs incurred in connection with raffle 
    activities during the reporting period shall be reported here. 
 
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 8.   ALL other expenses incurred in connection with raffle activities during the 
    reporting period shall be reported here.  This includes the license fee and 
    any professional fees such as legal expenses and accounting fees related 
    to the raffle operation. 
 
 9.  Total  Expenses of conducting raffle operations must equal the sum of 
    lines 1 – 8. Enter this amount on Page 1, Line 3. 
 
SIGN THE REPORT 
 
If total receipts (Schedule A, line 5) exceed $50,000, the financial return must be 
signed by a Certified or Licensed Public Accountant .
                                          
The completed report should be mailed to the Charitable Bingo/Raffle Unit, P.O. 
Box 1143, Charleston, West Virginia 25324-1143 by the applicable due date. 
 
Late reports are subject to a late fee of $25 for each month or portion of a month 
that the report is past due, up to a maximum of $100. After the maximum penalty 
is reached, the organization’s charitable raffle license will be suspended or 
revoked. 
 
LISTING OF CHECKS (Page 3)  
 
Provide a detailed list of all checks paid out of the raffle account. Use additional 
sheets if necessary. 
 
LISTING OF WINNERS (Page 4)  
 
West Virginia Code §47-21-22 requires  licensees to report the name, address 
and social security number of any individual who received prizes which valued in 
the aggregate more than one  hundred dollars during the course of any raffle 
occasion. Failure to report this information, or reporting fraudulent information, 
may subject the licensee organization to administrative or criminal penalties. 
 
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